Role of imaging in the diagnosis and staging of prostatic adenocarcinomas

: Early diagnosis of prostate cancer remains a subject of concern, if limitation of the number of unnecessary biopsies is the final goal. As long as a sufficiently sensitive and specific marker will not be available, high quality color-Doppler sonography remains a good adjunct to PSA assay to optimally select candidates to TRUS guided biopsies. Moreover, it greatly contributes to the local staging of clinically localized prostate cancer by targeting biopsies of the periprostatic spaces and seminal vesicles, when indicated. Endorectal MRI permits to assert for a given individual occult extraprostatic spread with a 95% specificity. However, it is only useful in patients with intermediate or high risk of pT3 stage, defined by the number of sextants involved on biopsy, PSA level and digital rectal examination findings. Indications of CT scanner and bone scan scintigraphy follow similar rules.